October 6, 2025

As we move into fall, our monthly education will focus on rehabilitation. Emergency Scene Rehab is more than rest and water—it’s a structured medical process that protects responders from heat stress, cold exposure, fatigue, and contamination while maintaining operational readiness.  

Once considered a “fireground-only” concern, rehabilitation is now recognized as a universal responsibility across every discipline in emergency response. Whether in suppression, EMS, HAZMAT, technical rescue, or tactical operations, responders face the same physiological stresses that can impair judgment, degrade performance, and increase the risk of injury or death. 

NFPA 1584 provides the foundation for how agencies should manage responder recovery and wellness during and after operations. We emphasize that rehabilitation applies to all incidents and training events that pose a risk of exceeding safe physical or mental endurance. It establishes the framework for relief from climatic conditions, reduction of contamination, hydration, nutrition, and mental decompression. 

Departments are encouraged to collaborate with their EMS medical director to develop Standard Operating Procedures (SOPs) and Standard Operating Guidelines (SOGs) that address these essential functions. These SOPs must outline when and how to establish rehab, the process for rotating crews, and how to manage personnel returning to service. They should also ensure accountability—tracking who enters rehab, what care they receive, and when they are cleared. Documenting rehab protects responders the same way charting protects patients. Agencies should conduct self-audits to ensure that procedures, training, and equipment meet NFPA 1584 standards before the next operational cycle. 

Before the next emergency occurs, ensure your department has integrated rehabilitation into every operation. Normalize its presence at every incident and make responder recovery as essential as scene safety. Rehabilitation is not optional, nor is it an interruption to the mission; it is a critical operational function. 

Until next week,

John B. Hill, MD

Emergency Medicine Physician

UH EMS Medical Director

UH Portage ED Associate Medical Director

NEOMED Clinical Assistant Professor

October 13, 2025

The term “prehabilitation” refers to proactive measures responders can take to ready their bodies and minds before facing the challenges of emergency operations. It involves hydration, nutrition, physical conditioning, and sufficient rest. All of these elements impact how effectively first responders perform under stress.  

NFPA 1582 specifies the medical and physical examinations candidates must pass to ensure they can safely perform essential job tasks. NFPA 1583 emphasizes the importance of maintaining a physical fitness program for emergency responders. Regular exercise, cardiovascular conditioning, and strength training are vital to meet the physical demands of the job. All first responders should maintain their fitness and readiness throughout their careers and are required to meet the standards in NFPA 1582. In fact, NFPA 1582 mandates an annual fitness evaluation, with restrictions on essential job tasks if personnel do not meet the specified aerobic capacity. 

Just as athletes warm up before competition, responders should engage in pre-event stretching and preparation to lower the risk of injury during drills or live operations. Hydration and nutrition also significantly impact performance and recovery. Responders should begin each shift well-hydrated and sustain proper electrolyte levels throughout their activities. Remember, the thirst mechanism is a delayed response; by the time you feel thirsty, you are already dehydrated by about one liter. Dehydration can reduce work capacity by up to 30%. Lastly, don’t forget the importance of sleep. Sleep deprivation and fatigue can impair decision-making as much as alcohol, making rest a vital part of readiness.  

Fire, EMS, and Police Departments can implement prehabilitation by scheduling active warm-ups at the start of the shift, before training, establishing hydration policies, and monitoring crew readiness. Supervisors should recognize signs of fatigue and ensure personnel are recovered before returning to service. Prehabilitation helps ensure that when the call comes, responders already have the physical and mental reserves needed to perform safely and effectively. 

Until next week,

John B. Hill, MD

Emergency Medicine Physician

UH EMS Medical Director

UH Portage ED Associate Medical Director

NEOMED Clinical Assistant Professor